TCI/TIVA Adult Case Studies
Total intravenous anaesthesia (TIVA) has many potential benefits, despite this, in many countries rates of TIVA remain low and education in the technique is lacking. This chapter considers the merits of Target Controlled Infusion (TCI) versus Manual Controlled Infusion (MCI), going on to consider appropriate dosing regimens for both hypnotic and opiate infusions. Detailed case studies are presented of induction and maintenance of general anesthesia and sedation. Appropriate doses in real life clinical scenarios are considered together with supporting evidence from published studies. A consideration of hypnotic/opiate interaction is also presented.
KeywordsAdults Anaesthesia, intravenous Anaesthetics, intravenous/pharmacokinetics Anaesthetics, intravenous/pharmacodynamics Clinical pharmacology Hypnotics and sedatives/administration and dosage Models, statistical Models, biological Propofol/pharmacokinetics Propofol/pharmacodynamics
(MP4 9652 KB)
- 1.Pandit JJ, Cook TM. Fifth National Audit Project of the Royal College of Anaesthetists in collaboration with the Association of Anaesthetists of Great Britain and Ireland: Accidental Awareness during General Anaesthesia in the United Kingdom and Ireland 2014. http://www.nationalauditprojects.org.uk/NAP5home.
- 3.Leslie K, Clavisi O, Hargrove J. Target-controlled infusion versus manually-controlled infusion of propofol for general anaesthesia or sedation in adults. Cochrane Database Syst Rev. 2008;16(3):CD006059.Google Scholar
- 4.Mazzarella B, Melloni C, Montanini S, Novelli GP, Peduto VA, Santandrea E, Vincenti E, Zattoni J. Comparison of manual infusion of propofol and target-controlled infusion: effectiveness, safety and acceptability. Minerva Anestesiol. 1999;65(10):701–9.Google Scholar
- 5.Marsh B, White M, Morton N, Kenny GNC. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 1991;67:41–8.Google Scholar
- 6.Peacock JE, Lewis RP, Reilly CS, Nimmo WS. Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients. Br J Anaesth. 1990;65(3):346–52.Google Scholar
- 9.Tzabar Y, Brydon C, Gillies GW. Induction of anaesthesia with midazolam and a target controlled propofol infusion. Anaesthesia. 1996;53(6):1–86.Google Scholar
- 10.Vuyk J, Mertens MJ, Olofsen E, Burm AG, Bovill JG. Propofol anesthesia and rational opioid selection: determination of optimal EC50-EC95 propofol-opioid concentrations that assure adequate anesthesia and a rapid return of consciousness. Anesthesiology. 1997;87(6):1549–62.CrossRefPubMedGoogle Scholar
- 16.Schuller PJ, Newell S, Strickland PA, Barry JJ. Response of bispectral index to neuromuscular block in awake volunteers. Br J Anesth. 2015;i95–i103.Google Scholar
- 17.Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresen C, Goodale DB, Youngs EJ. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88(5):1170–82.Google Scholar
- 19.Barakat A, Sutcliffe N, Schwab M. Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models. Anaesthesia. 2007;(5):661–6.Google Scholar